The Hindu Editorial Analysis- 12th January 2023 | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly - UPSC PDF Download

Reducing preterm births and stillbirths

Context

Nelson Mandela had said that “there can be no keener revelation of a society’s soul than the way in which it treats its children”. Two global reports released on January 10, 2023 — on child mortality and on stillbirths — prod us to reflect on whether India is doing enough for ensuring the health and survival of every child.

• In 2021, a staggering 5 million children died before reaching their fifth birthday. This is a tragedy on a personal level, and a setback to global development. The root cause of many of these deaths is a lack of access to basic rights such as quality healthcare, vaccinations, food, clean water, and sanitation. Despite ongoing efforts, preventable communicable and infectious diseases continue to take the lives of innocent children.

Children around the world face vastly different chances of survival. In 2021, the global under-five mortality rate was 38 deaths per 1,000 live births. However, in sub-Saharan Africa, the rate was 74 deaths per 1,000 live births. In low-income countries, the under-five mortality rate was 67 deaths per 1,000 live births, compared to just 5 deaths per 1,000 live births in high-income countries. The situation is similarly dire for older children and youth in sub-Saharan Africa, who face the highest probability of dying.

The burden of child deaths is disproportionately concentrated in certain regions of the world. In 2021, more children and youth died in sub-Saharan Africa and Southern Asia than in all other regions combined. Over 80% of under-five deaths and about 70% of all deaths among 5-24-year-olds occurred in these two regions. This highlights the need for increased recognition, prioritization, and action in these areas.

The first 28 days of life remain the most critical period for child survival. In 2021, approximately 2.3 million children died during the first month of life, or about 6,400 babies every day. These deaths accounted for nearly 47% of all under-five deaths that year. Children in sub-Saharan Africa continue to face the greatest risk of dying during this period.

Children aged 1-59 months accounted for 2.7 million of 2021’s under-five deaths. This burden is not evenly distributed across the world, with over 40% of all under-five deaths globally in 2021 among children in this age group in sub-Saharan Africa and Southern Asia. This highlights the need for renewed focus on addressing mortality among these children.

Conflict and emergencies, including the COVID-19 pandemic, continue to pose a significant threat to child survival. In 2021, the under-five mortality rate in countries classified as fragile and conflict-affected was triple the rate in other countries. While there is currently no systematic evidence of excess child mortality due to COVID-19, continued monitoring is needed given the potential impact of the pandemic on access to healthcare and intervention provision.

Data gaps are hindering efforts to end preventable child deaths. Quality data is vital to monitoring the survival of children from the neonatal period to young adulthood, particularly in conflict-affected situations. Investing in data collection mechanisms and systems is an essential part of realizing children’s rights and achieving the Sustainable Development Goals (SDGs).

About Child mortality

• Child mortality is the mortality of children under the age of five. 
• The child mortality rate, also under-five mortality rate, refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births.
  • It encompasses neonatal mortality and infant mortality (the probability of death in the first year of life).
• Reduction of child mortality is reflected in several of the United Nations' Sustainable Development Goals. 
  • Target 3.2 is "by 2030, end preventable deaths of newborns and children under 5 years of age”.
• Child mortality rates have decreased in the last 40 years worldwide.
  • Rapid progress in medical sciences has resulted in a significant decline.

Government initiatives for reduction of mortalities:

• India has taken up a number of innovative initiatives to reduce the mortalities due to malnutrition. 
  • Nutrition Rehabilitation Centre (NRC):
    • At the Nutrition Rehabilitation Centre (NRC) children with Severe Acute Malnutrition (SAM) are admitted. 
  • ICDS:
    • The Integrated Child Development Services (ICDS) scheme is one of the flagship programs of the Government of India. 
    • The beneficiaries under the Scheme are children in the age group of 0-6 years, pregnant women and lactating mothers.
    • Ministry of Women and Child Development is the implementing agency
  • Poshan Abhiyan:
    • It is intended to reduce stunting in identified districts of the country with the highest malnutrition burden by improving utilization of key Anganwadi Services and improving the quality of Anganwadi services delivery. 
  • Better feeding practices:
    • Under infant and young child feeding practices, guidelines are there to improve cognitive development, enhance weight gain and prevent malnutrition among children. 
  • Kangaroo Mother Care (KMC): 
    • KMCs have been found to be very effective for stable newborns in providing adequate thermal care, reducing nosocomial infections, improving exclusive breastfeeding and weight gain, besides fostering greater maternal and family involvement in care.
• Protecting mothers: 
  • Research suggests that the process of a baby’s brain development begins during pregnancy and is influenced by a pregnant woman’s health, nutrition and environment.
  • Hence, we need to understand that child survival cannot be addressed in isolation as it is intricately linked to the health of the mother. 
    • ‘Paalan 1000 – Journey of the First 1000 Days’, focuses more on the cognitive developments of children in the first 2 years of its life. 
      • On the other hand, PAALAN 1000 parenting app provides caregivers with practical advice on what they can do in their everyday routine and helps resolve the various doubts of parents and directs our efforts in the development of a child. 
    • Matritva Sahyog Yojana
      • It is a Conditional Maternity Benefit (CMB) Scheme launched in 2010.
      • The scheme is being implemented by the Ministry of Women and Child Development as the centrally sponsored scheme.
      • It was launched for pregnant and lactating women to improve their health and nutrition status to better-enable the environment by providing cash incentives to pregnant and nursing mothers.
    • National Nutrition Mission:
      • It is the government’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers.
      • Aim: To reduce stunting and wasting by 2 percent per year (total 6 per cent until 2022) among children and anaemia by 3 percent per year (total 9 per cent until 2022) among children, adolescent girls and pregnant women and lactating mothers.
      • The Ministry of Women and Child Development is the nodal ministry for implementation.

Way Ahead

• With these measures in place, we can expect some more concrete and positive health related changes in the days to come.
• India is poised to meet 2030 Sustainable Development Goals targets of child mortality with focused interventions, strong Centre-State partnership, and dedication of all health workers.